Integrating hypochloremia and venous congestion to predict acute kidney injury in acute heart failure
F Ben Ghorbel, S Antit, L ZakhamaAbstract
Background
Electrolyte disturbances are common in acute heart failure (AHF) and reflect neurohormonal activation and renal dysfunction related to hypoperfusion and venous congestion. Hypochloremia has been associated with disease severity, but its prognostic value for acute kidney injury (AKI) remains uncertain. The Venous Excess Ultrasound (VExUS) score allows non-invasive assessment of systemic venous congestion and may improve risk stratification.
Purpose
To assess the association between admission hypochloremia, venous congestion assessed by the VExUS score, and the occurrence of AKI in patients hospitalized for AHF.
Methods
We conducted a monocentric prospective study including consecutive adult patients admitted to the intensive care unit for acute de novo or acutely decompensated chronic heart failure between February and December 2024. Patients with severe baseline renal dysfunction, chronic dialysis, liver cirrhosis, or inferior vena cava thrombosis were excluded. Laboratory measurements were performed at admission, before initiation of intravenous loop diuretic therapy, and VExUS score was systematically assessed 24 hours after admission Clinical, laboratory, and echocardiographic data were collected during hospitalization. Renal function was evaluated during hospitalization and up to 6 months after discharge. AKI was defined according to standard criteria.
Results
Eighty-seven patients were included; 67 (77%) developed AKI during follow-up. Among patients with AKI, 62.7% had severe venous congestion (VExUS grade 3) and 43.3% had hypochloremia (serum chloride <96 mmol/L). In multivariable analysis, AKI was independently associated with VExUS grade 3 (OR 2.84, 95% CI 1.01–9.21; p=0.047) and hypochloremia (OR 4.32, 95% CI 1.15–16.20; p=0.030). The VExUS score showed good discrimination for AKI (AUC 0.76). The combination of VExUS grade 3 and hypochloremia showed higher discriminative performance (AUC 0.82).
Conclusion
In patients with AHF, AKI is associated with severe venous congestion and hypochloremia. The combined assessment of VExUS and serum chloride may help identify patients at increased risk of AKI.